Chapter 21 - Response to nonsurgical therapy (Terms: (Prophylaxis: removal…
Chapter 21 - Response to nonsurgical therapy
: mechanical removal of supragingival and subgingival dental biofilm, calculus, and stains
: definitive treatment procedure designed to remove cementum or surface dentin that is rough, impregnated with calculus or contaminated with toxins or microorganisms
: removal of any foreign material, including dental biofilm, its by-products and toxins, calculus, and diseased or dead tissue from the coronal surfaces, root surfaces, sulcus or pockets and periodontium
The difference between periodontal debridement and scaling and root planing is that it encompasses more than just the root surfaces. it includes the pocket space, the pocket wall, and the underlying tissues. The objective of periodontal debridement is the control of bacterial infection
: mechanical removal of dental biofilm and calculus from tooth surfaces above the gingival margin
Sub gingival debridement:
removal of biofilm and calculus from root surfaces below gingival margin
: mechanical disruption of nonattached, free-floating, subgingival biofilm and its byproducts from the sulcus or pocket
: removal of biofilm, calculus, and stains from the eposed and unexposed surfaces of the theeth by scaling and polishing as a preventitive measure for the control of local irritants
Polishing is performed to remove stains from the teeth. There are no major theraputic benefits to polishing therefore it should be performed selectively when teeth have extrinsic stains. Most people associate polishing with the actual "cleaning" and want all of their teeth polished.
Curettage: involves removal of the diseased lining of the soft-tissue pocket wall including the JE and the underlying inflamed connective tissue
The goal of this treatment is to reduce periodontal inflammation
The clinical significance of root surface smoothness is still undetermined. The hygienist should stive to remove as much subgingival calculus as possible. It used to be assumed that bacteria will accumulate to any rough surface, such as cementum and subgingival calculus, and should be smoothed out.
Periodontal instrumentation is performed during the initial or preliminary phase of periodontal therapy. It benefits of periodontal debridement combined with oral hygiene self-care in the treatment and prevention of periodontal diseases have been well documented.
Numerous studies over the years have shown that subgingival biofilm control has more success in the prevention of clinical attachment loss than supragingival biofilm removal alone
Indications for periodontal debridement: 1) signs of gingival inflammation 2) elevated levels of bacterial pathogens 3) progressive attachemnt or alveolar bone loss
Intended outcomes of periodontal debridement: the long-term outcome is preservation of the form and function of the dentition. Most clinical studies use probing depths, clinical attachment changes, and alveolar bone height to measure success of periodontal treatment
Root planning is contraindicated in sites that do not have periodontal pockets. Root planning on sites with 3mm or less probing depths has resulted in attachment loss. Care in selecting sites that will benefit from subgingival debridement is essential in the prevention of clinical attachment loss
Periodontal debridement has not been shown to produce long term shifts in the pathogenic bacteria that populate the pocket.
Average reduced bleeing inof about 57% after treatment
Most patients require the use of anesthesia, usually applied in quadrants. It is recommended to treat one or two quadrants at a time, usually on the same side of the mouth so the entire mouth is not numb and the patient can function somewhat normally the rest of the day.
Before treatment, it is important to educate the patient on the expected outcome of the procedure and why the the procedure is needed. It is imperative to get informed consent before starting treatment
Subgingival debridement: the primary goal once treatment is started is to remove gross deposits from supragingival and subgingival tooth surfaces. You want to eventually remove all biofilm, calculus, and endotoxins to enable soft-tissue healing. Keep in mind that complete calculus removal may not be attainable
Root surface characteristics if elimination of subgingival bacteria is not accomplished, rapid re-growth and maturation will occur.
Cementum removal: There are no firm conclusions about either the feasibility of tor the need for removal of all contaminated cementum. Most literature recommends toward the elimination of just the necrotic cementum
Adverse effects of debridement: subgingival debridement may cause soft-tissue recession, making teeth look longer and exposing the root surface. This can result in dental hypersensitivity as a result of removing the outer layer of cementum. This sensitivity may take 3-4 days to occur
It is important to talk to the patient before treatment about the possibility of dental sensitivity and how long it may last after treatment
Limitations of periodontal debridement: Root debridement does not always remove biofilm. Current conclusions about the effectiveness of periodontal debridement in deeper pockets are conflicting and there is not agreement on whether tis treatment is effective in advanced periodontitis
Greater pocket depths present a challenge for regular instrumentation to reach. The patient would need to have more advanced treatment at that point
Access for instrumentation in the furcation area is often difficult. Knowledge about the morphology of tooth structure is important for effective instrumentation.
Time and clinician skill: debridement should take about 10 minutes per tooth.
The best way to determine how much root planning is needed is by monitoring tissue healing after treatment. If inflammation persists than more debridement is required.
The major outcome of debridement is tissue healing and decreased probing depths
"long junction epithelium" reattachment of the epithelium to the tooth. results in closure of the pocket. This usually occurs within one week of treatment
Apparent gain in attachment level can be measured after 4-8 weeks
Reevaluation of initial therapy: should be conducted between 4-8 weeks after treatment
With favorable treatment, the patient should be placed on periodontal maintenance and reevaluated in 2-3 months because that is about how long it takes to repopulate subgingivally after debridemnt
Tissue healing response is similar with manual and ultrasonic instrumentation
Lasers: Minimal evidence supports the use of lasers in periodontal therapy however they continue to be a popular treatment option